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SANOAQUIN <br /> (91 Environmental Health Department <br /> COUNTY---- <br /> ��yrRQa�P' Greotness grows here. <br /> ��?? Monitoring Well/Soil Boring Inspection Report <br /> U <br /> Date: 220 Inspector: 5,A CONSTRUCTION <br /> Facility Address: Q70 N iPa rkt r r fm <br /> Well Address: Total Depth:. <br /> WP# Do IA 10 I Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite 0& j Screen Length From: To: <br /> Consultant: [(`d. <br /> Filter Pack From: To: <br /> Geologist: �bq�fi�ivv <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COt"FLETION CCOOMP�LET]ION <br /> Method: Ground Suufxs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: abnad - E <br /> sacdon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ __ <br /> Depth to Water: n• n' <br /> Grout Material: M CQmLdIE <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation lyBoring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> 1 Water ement 4 b Water Cement 941b <br /> gallons Bas gall ons Bags <br /> Thickest Thinnest 0Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 15 30 3 <br /> 10 20 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />